PAINT/BODY SHOP QUESTIONNAIRE - AmTrust North America

FDIC #:LOC #:Date:*To be able to save this form after the fields are filled in, you will need to have Adobe Reader 9 or later. If you do not haveversion 9 or later, please download the free tool at: http://get.adobe.com/reader/.PAINT/BODY SHOP QUESTIONNAIRENAMED INSURED:1. Please enter total number of experience in principle trade.2. Please enter total number of years of business ownership experience.3. Do you have an established store front?4. Please indicate total number of employees. Full Time Part Time5. Number of ASE certified mechanics.6. Do you have access to current technical service bulletins?7. Do you have scheduled facility inspections and a documented safety program in place?YesYesNoNo8. General Housekeeping Practices?MinimalInformalFormal9. Smoking allowed on premises?If so, is there a designated smoking area away from building?10. Do you loan or rent vehicles to customers?11. Do you offer mobile repair service?12. Any guard dogs on premises?13. Any other occupants on insured premises?14. Have you ever been cited for any EPA Violations?YesYesYesYesYesYesYesNoNoNoNoNoNoNo15. Please indicate the percentage of work applicable to: Private Passenger Medium Heavy Trucks16. Is work done on buses, recreational vehicles, emergency vehicles or any other vehicles used for public transportation?17. Do you specialize in any of the following categories? (indicate percentage applicable to each)Brake Work Transmission Repair Major Engine Overhaul18. Do you subcontract any work to other service or repair shops?19. Do you engage in any of these activities? (check applicable boxes)New Auto Parts Sales Used Auto Parts Sales New Tire Sales Used Tire SalesMachine ShopNone Applicable20. Do you engage in any used auto sales? (include autos rebuilt for sale)If so, how many dealer plates do you currently have?21. Do you operate a wrecker service other than for vehicles brought in for general repairs?YesYesYesYesNoNoNoNo

22. Do you have signs indicating the shop floor is off limits to customers?23. Do you have a designated customer waiting area?24. Is premises protected by an electronic alarm system?25. How are customer keys controlled?26. Do you test drive vehicles? Yes NoIf so, do you have a planned route?YesYesYesYesNoNoNoNo27. Are customer vehicles kept overnight? Yes No If yes, please indicate: Max # inside Max # outside28. Is lot Fenced?29. Well-kept documentation of work performed?30. Does shop have Pits?If so, are there procedures in place for verbal double-checking between Pit & Top side workers?31. Any welding on premises?32. Any specialized work for speed or racing preformed?33. Does insured have any affiliation with auto and/or truck racing?34. Describe storage of flammable & combustible liquids.35. How are waste fluids disposed of & how often?36. Do you use metal containers with self closing lids for oily rags?37. Are there currently serviced, charged & operable fire extinguishers on premises?38. Do you have underground gasoline storage tanks?If yes, please describeAge of Tanks:Describe leak monitoring methods:39. Is there any spray painting done?If so, please answer the following questions:Construction of Tanks:(a) Is there a separation in the building from other Operations?(b) Is the booth UL approved?(c) Does the spray booth have sprinkler protection or alternate protection, i.e., dry chemical?(d) If so, what is the last date of service?(e) Is there explosion-proof lighting?(f) Is there proper ventilation?(g) How often are booth filters changed?(h) Who is responsible for changing the booth filters?(i) Are flammable/combustible liquid in or near the spray booth limited to amounts needed that day or that shift?(j) Any open containers of flammable/combustible liquid?(k) Is the painting mixing area enclosed in a non-combustible enclosure with a self-closing metal door, poweredventilation, explosion-proof electrical and lighting?YesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesNoNoNoNoNoNoNoNoNoNoNoNoNoNoNoNoNoNoNoNo5800 Lombardo Center • Cleveland, OH 44131 216.328.6166 • www.amtrustgroup.com